Avoidant/Restrictive Food Intake Disorder (ARFID), oftentimes characterized as “extreme picky eating,” is an eating disorder impacting thousands of individuals, particularly children. There are three main types of ARFID:
- Lack of interest: people with this type of ARFID have a genuine lack of interest in eating and food. They also get full quickly.
- Sensory Avoidance: people with sensory avoidance have issues with food tastes, textures, temperature and smells.
- Fear of Aversive Consequences; people with a fear of illness, choking, nausea and allergies related to food.
What are the effects of ARFID?
Because ARFID leads to avoidance of certain foods and food groups, it can impact the body and brain in many ways. Below are some effects of ARFID, which may or may not be present in people diagnosed with this eating disorder.
Physical effects
Over time, avoidant/restrictive food intake disorder can cause malnutrition. Malnutrition is linked to many health issues, such as impacts on hormones and development caused by nutrient deficiencies. This can cause problems in bone health, and for women, amenorrhea (loss of a menstrual period). You can learn more about the health impacts of malnutrition by reading our blog.
Mental health
Chronic stress from under-eating increases cortisol levels, which may increase the risk of anxiety and depression. Many children with ARFID also have a co-occurring anxiety disorder, and they are also at high risk for other psychiatric disorders.
Social impacts
Some individuals with ARFID may choose to eat alone in order to conceal their symptoms, which can lead to feelings of loneliness and isolation as they fear being misunderstood by others. Children with ARFID may avoid social gatherings involving food, such as parties or special occasions, as well as any setting where food is present. The social aspect of school meals can cause significant stress and anxiety for many children, impacting their academic performance. Additionally, children may opt out of extracurricular activities that involve eating.
As adults, individuals with ARFID often continue these avoidance behaviors, which can hinder their social interactions and participation in group activities. This may limit their career advancement opportunities, as discomfort with socializing can impede networking and collaboration. Many adults with ARFID have never fully acclimated to social situations due to their avoidance of activities involving food, which perpetuates their discomfort and anxiety in social settings.
How is ARFID treated?
CBT – ARFID
Cognitive Behavioral Therapy, or CBT, is a psychological treatment that uses the connection between thoughts, feelings and physical sensations to address maladaptive behaviors in a less overwhelming way. There is a specific type of CBT for ARFID (CBT-ARFID) that is widely used by dietitians and therapists. The goals of CBT-ARFID are to achieve a healthy weight, correct nutritional deficiencies, eat foods from the basic food groups and feel more comfortable eating in social situations. CBT-ARFID uses several sessions to go through stages such as learning about the disease, making early changes, setting big goals, facing their fears and preventing relapse.
Exposure Therapy
Exposure therapy involves “exposing” the person to their perceived fear, in this case, food that provokes anxiety, using smells, imagery, and mental visualization. Usually, dietitians will work on a hierarchy of fear foods from the least fearful to most anxiety provoking. Over time the dietitian will expose the person to the idea, smell, texture, sight and eventually the taste of the feared food until the person is no longer anxious around that specific food. It should be noted that not all fear foods will be exposed, and the dietitian works in collaboration with the individual to help them move towards foods that they would like to incorporate into their life.
Food chaining is one strategy that can help people try new foods or fear foods. The goal is to create “chains” or links between foods that they already eat and new foods that would support their growth health and goals The food is prepared in a way that is least overwhelming and stressful, and then moves gradually towards the food in its most challenging form. For example, if the fear food is blueberries, a person could start with a blueberry muffin, and gradually move to blueberry juice, blueberry yogurt and eventually to blueberries themselves.
What now?
Coping with ARFID can be a lonely and isolating experience, but there are many tools and professionals available to help one in their journey towards recovery, whatever that may look like for each person.An interdisciplinary team can involve a registered dietitian, occupational therapist, speech language therapist, psychologist and/or psychiatrist. At Sööma, our dietitians specialize in using the treatment methods above to help clients with ARFID. Reach out to us for more information or to learn how we can help!
By: Elsa Chu, Registered Dietitian
Sööma est une entreprise bilingue qui fonctionne en anglais et en français. Nous fournissons des articles de blogue, des recettes et des articles de diverses sources qui sont parfois écrits en anglais et parfois en français. Si vous vous sentez incapable d’accéder à un article ou à un sujet spécifique en raison d’une barrière linguistique, veuillez nous contacter à info@sooma.ca et nous serons heureux de traduire le contenu pour vous.
Sööma is a bilingual company that operates in both English and in French. We will provide blog posts, recipes and articles from various sources that are sometimes written in English and sometimes in French. If you feel unable to access a specific article or topic due to a language barrier, please reach out to us at info@sooma.ca and we will be happy to translate the content for you.
References
- Fear, M. F. (2020, October 18). Social Impact of ARFID. My Food Fear. https://www.myfoodfear.com/social-impact-of-arfid/
- Thomas, J.J. and Eddy, K.T. (2019). Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, & Adults. Cambridge: Cambridge University Press.
- ©2018 Boston Children’s Hospital | Center for Young Women’s Health | Written by Katelyn Castro, MS, RD
- Contributor, D. (2019, October 22). ARFID Treatment Options. Center For Discovery. https://centerfordiscovery.com/blog/afrid-treatment-options-summary/
- Fraker C, Fishbein M, Cox S, Walbert L. Food Chaining: The proven 6-step plan to stop picky eating, solve feeding problems, and expand your child’s diet (2007)
- Michel, A. (2022, July 27). Physical Effects of ARFID. The Emily Program. https://www.emilyprogram.com/blog/physical-effects-of-arfid/
- Center for Discovery. (2021, August 13). What is ARFID: Symptoms, Causes, and Complications. https://centerfordiscovery.com/conditions/arfid/
- NEDIC | Avoidant and Restrictive Food Intake Disorder. (2022). National Eating Disorder Information Centre. https://nedic.ca/eating-disorders-treatment/avoidant-and-restrictive-food-intake-disorder/
- Stage 1: Psychoeducation and Early Change. (2019). https://doi.org/10.1017/9781108233170.008
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NEDA. (2018, February 22). Avoidant Restrictive Food Intake Disorder (ARFID). Retrieved from National Eating Disorders Association website: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid
